Labour steps cautiously up to difficult truths about the NHS

At last, a shadow minister says budgets would be tight and reform essential regardless of who was in power.

We know Labour loves the NHS. All British political parties are obliged to profess their undying devotion to the health service at routine intervals, but Labour, as the party that oversaw the creation of the NHS (and has, in recent memory, invested the most money in it) claims a special protective monopoly. Voters seem to recognise this and regularly award Ed Miliband’s party robust leads on questions of who is most trusted on the issue.

That advantage is sure to be extended as the government’s NHS reforms, combined with an unprecedented budget squeeze, reinforce the impression that the Tories inevitably succumb to vandalistic urges towards the health service.

Even without the Lansley reforms (now to be implemented by Jeremy Hunt, who has never knowingly inspired confidence in anyone apart, it seems, from the Prime Minister) the NHS would be causing headaches for the coalition.  The health budget may be “ring-fenced” but anything other than a real terms rise in spending feels, over time, like a nasty cut, given inflation in the cost of treatments and the growing demands of caring for an ageing population.

That would be a problem for Labour in government too although you don’t often hear opposition MPs advertise the fact. Why would they? Slamming David Cameron for trashing the NHS is an open goal for Ed Miliband; it would just complicate the goal-scoring manoeuvre to add mealy-mouthed acknowledgements of the immovable budget obstacles on the horizon. That, at least, is one argument and it has generally prevailed at the top of the Labour party.

There is another view, which is that the public are not fools and will, as an election approaches, expect to hear something about the opposition’s intentions towards the NHS other than “we wouldn’t be the Tories”. As I’ve argued (ad nauseam) in the past, a necessary step on Labour’s journey to governing credibility, especially with regard to fiscal responsibility, is being seen and heard to talk about innovation and reform of public services. This doesn’t have to be a macho breast-beating display of willingness to wield the axe. It just means demonstrating, by the deployment of some policy imagination, that Labour recognises the long-term obligation to find ways of getting more for less.

With that in mind, I was heartened to come across a speech yesterday given by Liz Kendall, shadow minister for social care. Not many people spend their weekends catching up on policy interventions by junior ranking shadow cabinet figures, so I suspect you may not have yet got round to reading this particular example of the genre. It is not the Gettysburg address, nor is it a complete exposition of Labour’s policy towards reforming the health service. As with everything else in Labour's agenda for government (with good reason, given the time still to run before an election) health policy is a work in progress.

Nonetheless, for those of us who try to decrypt dull Labour announcements, scouring the formless surface of cosy One Nation reassurance for signs of something that looks like progress towards a governing position, Kendall’s speech is a find.

She states, for example that:

The truth is that far more fundamental reform is vital if we’re going to meet the challenges of demographic and social change.

And that:

.. Whichever party is in Government and however much growth we get back into the economy, we’ve got to get far more out of the billions of pounds spent in the NHS into the foreseeable future.

Obviously true, and a few grades below rocket science, but refreshing to hear said aloud by a shadow cabinet minister.

Kendall clarifies, up to a point, Labour’s view on what would happen to the new NHS architecture currently being put in place by the coalition if Ed Miliband were prime minister.

If Labour wins the next election we will repeal the 2012 Health and Social Care Act but we will not force the NHS through another major re-organisation.

We don’t need new NHS organisations, we’ll simply ask those we inherit to work differently.

We’ll keep Clinical Commissioning Groups and Health and Wellbeing Boards, but ensure they work within a properly accountable national health service.

And what about this for a realistic account of how the opposition should behave towards hospital  reconfigurations (a euphemism for the movement of services out of hospitals, into the community, usually involving ward closures, demonstrations, angry public meetings, bad headlines etc.):

Whilst changes to local hospital services will always be difficult, Labour will not have a policy of blanket opposition to hospital reconfigurations like the Conservatives did at the last election.

That might be easy politics. But it wouldn’t be right in principle or in practice.

We will judge every proposal on its merits: whether it saves more lives, reduces disabilities, and improves the quality of care. The clinical case must be made and supported by the evidence, if the public as well as local MPs are to be convinced.

In other words, yes, sometimes wards and even hospitals will have to close if we’re serious about finding the most effective and efficient way to deliver modern health services. That is because vast old district general hospitals are a desperately outmoded way of looking after people, many of whom have chronic conditions that should be treated not in hospital beds but at home or at local clinics. Better still, such conditions should prevented or kept in check by lifestyle changes. It’s what nearly everyone who has looked at the long-term implications of health policy decides in the end, but you rarely hear opposition politicians say it because joining in the anti-closure demo is so much more rewarding in the political short term.

Kendall even talks about “innovation” in the health service and the need to take a non-dogmatic view of the role of private and voluntary sector providers:

For all the criticism you hear, there’s actually a huge desire and talent for innovation amongst NHS staff.

What they need is the encouragement, freedom and space to innovate. They need backing to experiment and take sensible risks, not rigid performance management from on high.

The private and voluntary sectors also have a vital role to play in bringing innovation and challenge into the system.

Of course private and voluntary providers must be effectively commissioned and regulated, within a properly managed system - not the free market, free-for-all that this Government is putting in place.

But it would be a real mistake to slip back into old ways of thinking, and attempt to block rather than encourage the benefits these services can bring.

To most people who think about the challenge of running a decent public sector on limited budgets, that is all perfectly sensible. It is also, however, by the standards of recent Labour party caution in the discussion of public sector reform and given the reactionary mood in some corners of the wider labour movement, quite a departure. Brave, even. A modest burst of level-headed realism from a shadow minister about the challenge of running services in straightened times, acknowledging the need for innovation and reform that might not always be popular at first - I wonder if it will catch on.

The Olympic opening ceremony celebrating the NHS. Source: Getty Images

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

Show Hide image

Stability is essential to solve the pension problem

The new chancellor must ensure we have a period of stability for pension policymaking in order for everyone to acclimatise to a new era of personal responsibility in retirement, says 

There was a time when retirement seemed to take care of itself. It was normal to work, retire and then receive the state pension plus a company final salary pension, often a fairly generous figure, which also paid out to a spouse or partner on death.

That normality simply doesn’t exist for most people in 2016. There is much less certainty on what retirement looks like. The genesis of these experiences also starts much earlier. As final salary schemes fall out of favour, the UK is reaching a tipping point where savings in ‘defined contribution’ pension schemes become the most prevalent form of traditional retirement saving.

Saving for a ‘pension’ can mean a multitude of different things and the way your savings are organised can make a big difference to whether or not you are able to do what you planned in your later life – and also how your money is treated once you die.

George Osborne established a place for himself in the canon of personal savings policy through the introduction of ‘freedom and choice’ in pensions in 2015. This changed the rules dramatically, and gave pension income a level of public interest it had never seen before. Effectively the policymakers changed the rules, left the ring and took the ropes with them as we entered a new era of personal responsibility in retirement.

But what difference has that made? Have people changed their plans as a result, and what does 'normal' for retirement income look like now?

Old Mutual Wealth has just released. with YouGov, its third detailed survey of how people in the UK are planning their income needs in retirement. What is becoming clear is that 'normal' looks nothing like it did before. People have adjusted and are operating according to a new normal.

In the new normal, people are reliant on multiple sources of income in retirement, including actively using their home, as more people anticipate downsizing to provide some income. 24 per cent of future retirees have said they would consider releasing value from their home in one way or another.

In the new normal, working beyond your state pension age is no longer seen as drudgery. With increasing longevity, the appeal of keeping busy with work has grown. Almost one-third of future retirees are expecting work to provide some of their income in retirement, with just under half suggesting one of the reasons for doing so would be to maintain social interaction.

The new normal means less binary decision-making. Each choice an individual makes along the way becomes critical, and the answers themselves are less obvious. How do you best invest your savings? Where is the best place for a rainy day fund? How do you want to take income in the future and what happens to your assets when you die?

 An abundance of choices to provide answers to the above questions is good, but too much choice can paralyse decision-making. The new normal requires a plan earlier in life.

All the while, policymakers have continued to give people plenty of things to think about. In the past 12 months alone, the previous chancellor deliberated over whether – and how – to cut pension tax relief for higher earners. The ‘pensions-ISA’ system was mooted as the culmination of a project to hand savers complete control over their retirement savings, while also providing a welcome boost to Treasury coffers in the short term.

During her time as pensions minister, Baroness Altmann voiced her support for the current system of taxing pension income, rather than contributions, indicating a split between the DWP and HM Treasury on the matter. Baroness Altmann’s replacement at the DWP is Richard Harrington. It remains to be seen how much influence he will have and on what side of the camp he sits regarding taxing pensions.

Meanwhile, Philip Hammond has entered the Treasury while our new Prime Minister calls for greater unity. Following a tumultuous time for pensions, a change in tone towards greater unity and cross-department collaboration would be very welcome.

In order for everyone to acclimatise properly to the new normal, the new chancellor should commit to a return to a longer-term, strategic approach to pensions policymaking, enabling all parties, from regulators and providers to customers, to make decisions with confidence that the landscape will not continue to shift as fundamentally as it has in recent times.

Steven Levin is CEO of investment platforms at Old Mutual Wealth.

To view all of Old Mutual Wealth’s retirement reports, visit: products-and-investments/ pensions/pensions2015/